Every year, towards the beginning of December, the Global Malaria Programme (GMP) at the World Health Organization (WHO) releases the World Malaria Report (WMR) for the prior year –importantly, in the context of the 2020 pandemic, the reports covers the data from 2019. This constitutes the most comprehensive compendium of malaria data and the basis for strategic planning for a wide range of stakeholders.
On this occasion, the report also reviews the evolution of malaria over the last two decades, and reiterates a trend first observed in 2017, when the extraordinary advances achieved since the year 2000 stagnated and even worsened in many regions of the world. The GMP presents this bittersweet mélange of data along with a clear call to reinvigorate the efforts, enhance commitment, empower the National Malaria Control Programmes and support research and development to ensure that innovative tools are available as soon as possible.
On this occasion, the World Malaria Report reviews the evolution of malaria over the last two decades, and reiterates a trend first observed in 2017, when the extraordinary advances achieved since the year 2000 stagnated and even worsened in many regions of the world
Compared to the global malaria context in 2000, data from 2019 are simply extraordinary on all fronts, including funding, implementation of key malaria interventions, and the number of countries on track to eliminate malaria from their territories in the coming 2 to 5 years. To give just one example: overall, the number of households that own at least one bed net to protect their inhabitants from mosquito bites rose from 5% to 68% over the two first decades of this century.
As highlighted by Pedro Alonso, director of Global Malaria Programme, this and other equally impressive achievements are the result of new institutions and funding mechanisms, renewed strategic thinking and innovative tools. The outcome is the prevention of an estimated 7.6 million deaths due to malaria in the past two decades.
Evidence of significant advances over the past several years in the countries with the lowest malaria burden, is reflected by the progressive certification of elimination as planned in the Global Malaria Action Plan (2016-2030), with China and El Salvador likely to be the next two countries to be evaluated for certification by WHO – that is, not only documented to be ‘malaria free’, but with clear systems and commitments to maintain vigilance against importations and respond rapidly to prevent sustained transmission in the future.
Challenges remain, however, and they are serious and unrelenting. Since 2017, as evidenced by two key indicators: incidence of malaria and mortality rate, the highest burden countries in sub-Saharan Africa have stalled or improved in only very modest ways, despite most recent efforts catalyzed by WHO to address malaria precisely in these areas.
Challenges remain and they are serious and unrelenting. Since 2017, as evidenced by two key indicators: incidence of malaria and mortality rate, the highest burden countries in sub-Saharan Africa have stalled or improved in only very modest ways
The GMP High Burden High Impact initiative focuses on making the best possible use of scarce resources through strategies tailored to each specific subnational context, rather than making a single strategy for entire countries. The approach relies on high quality epidemiological data to make informed decisions, and it is encouraging to realize how much the available data has improved over the last 20 years, as pointed out by the lead author of the World Malaria Report (WMR), Abdisalan Noor.
But both Noor and Alonso make clear that such tailored approaches won’t suffice to revert the ongoing trends in highest burden countries. The world urgently needs new tools: drugs, vector control and vaccines, and combination strategies. They further make a call for empowerment of each National Malaria Control Programme, even if most of their funding comes from abroad. Experience shows that real success in malaria has been led by the endemic countries leading the fight. National leadership is key to long term success in malaria.
The world urgently needs new tools: drugs, vector control and vaccines, and combination strategies
This year’s report does not reflect the impact of the ongoing COVID-19 pandemic on malaria programmes. However, the active engagement of WHO GMP with the RBM Partnership to End Malaria and other partners served to ensure that potential delays in malaria services were overcome, from planned bed net distribution to access to critical medicines. The worst case scenario modelled last April –which predicted that malaria deaths could double if provision of malaria interventions was severely disrupted- has not been the case.
Overall, there is room for optimism, reinforced by the observation of how fast the malaria community responded to the threats posed by COVID-19 and organized work streams to address challenges as varied as pressures on the production of antimalarial drugs, manufacturing bottle necks or disruptions in health systems.
But in order to make the situation improve, WHO calls on endemic countries and their malaria partners to step up the fight against malaria and fill the existing gaps in access to the tools that prevent and cure malaria, and save lives. Building on the collaborative spirit that emerged during the pandemic and advancing local strategic thinking, funding and research, the global malaria community should be able to ensure that each malaria endemic country addresses its specific challenges and contributes to the global progress towards a malaria free world.